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HomeMy WebLinkAbout032-2167-36-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 605044 GENERAL INFORMATION State Plan ID N Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. NR Permit Holder's Name: City Village Township Parcel Tax No: Patrick Sheridan TOWN OF SOMERSET 032-2167-36-000 CST BM Elev: 19Insp. BM Elev: BM Description: Sectio /Town/Range/Map No: 0,2-S+ 26.31.19.1416 TANK INFORMATION ELEVATIO DAT TYPE MANUFACTURER CAPACITY ST ION BS HI FS ELEV. Septic aw- Benchmark Clrl L T-. L Dosing Alt. BM I I Aer Bldg. Sewer Holdi St/Ht Inlet et ~ TANK SETBA INFORMATI0 U Ou TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/M 7.q 00-01 Aeration Dist. ID 7 o~C 7 O c Holding Bot. System 8.515 8160 Final Grade ~.t__1 PUMP/SIPHON INFORMATION :J I Manuf r De d St Cover M del Number T H Lift Friction Loss Syst ead TDH Force in Length Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width 1 Length , Of Trenches PIT DIMENSIONS No. Of P' Inside Di,. Liquid Depth DIMENSIONS r o I I'll SETBACK SYSTEM TO / BLDG WELL LAKE/STREA LEACHING Manufa t c .j, INFORMATION Ty p_ Of System, ` lob I CHA UN MBER OR IT Model Nu r: , v U N ~ 7 DISTRIBUT N SYSTEM ' qh Header nifold Distribution x Hole Size x Hole Spacing Vent to Air Intake I e(s) Length-W_ Dia Length , ` E SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over f Depth Over ` xx Depth of xx Seeded/Sodded xx Mulched yes t No Bed/Trench Center Bed/Trench Edges 7 I Z to Topsoil N JJJ / ! '1 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Ins a ion #2: Location: 668 196TH AVE D v ~v C ~ ~ 1.) Alt BM Description = 1 (V V t~ p~ 2.) Bldg sewer length - - amount of cover Plan revision Required? Yes ~ No Use other side for additional information. Date ksodpctor's Signature Cert. No. SBD-6710 (R.3/97) ~~EC~.nrarp,~,, AX jj~ t,o my ~ Safet and Buildings Dtulslon l t r "ri 201 W. Washington Ave_, 1'. t?. Box 7162 Sanitary Pernut Number (to be filled in by Co,) , g 1` ' Mattison, WI 53707-7162 - - State Transa tign Number Pchnit Applzca xoi~ In :u:cordnnr:c v~ ill 1 ~1~~de, submission Pf this In me tal "nit - - is required prior to~nt~ tg°a" sanitary permit. Note: Application forms for state-owned POWTS arc mined i Project Address (1f different than mailing address) tlx. Depatimcnt of Safety and Professional Servics, personal information yon provide may he used for secondary p+nposes nt accordance with the Privacy Law, s. 1~5-Q4 1 m State. A I„ ~ 19 6 ~ - - - - v✓ `v t Application Information Please Print All 1 o ation- Propcov Owner's Nanle Parcel t - - - --Properly ( )Owner's Mailing Address Property l,ncatian 1 3 ~d - lt sr ~l< ~~jj - _ Govt- Lot - - - -v-l C t1} Slaty Zip Codc Pbone Number ti Section alt r (circle one) ! T ..j/----- N' R ~y- - F_ nt(S> Il. 'I'y pc of [iuilding (ehecl( all that apply) Lot it - I ~1 rn 2Pamiiy F)lCllinp-Nunhcr ofcdroo Iilnc ~ Suh~div.isiv on N~ ame 1 F'nblic/C:ommrroial Describe Use G4 ❑ City of- a 11St:+fc Owned- I)rscdhe Ilse Village of Town ofY11 ' - - ~ ill. 'type of if ez nrrt: ((,heck only on box on line A. Comiplete h>rfle iEi if applicahle) A 1 1 Nee3 System Replacement System Ll Treatment/Holding Tank Replacc inviv Only ❑ Other Modification to Fxisti y em (e in} h• 1~ I erntit. Renewal Pet'mit Revision ❑ Change of Plumber n Permit Transfer to New List Previous Permit Number and Date Issued Ilefcnc Iixpirat.ion Owner - lV 'I y}TC of POWTS_Systena/Component/Dev_ice.: (Check all that ap1) ly) - - - Non-Prrc5uri2ed In Ground ❑ Prrssuri7ad In-Ground ❑ At-Grade {_1 TAountl ?_4 +n, of suitable soil ❑ Mound < 24 in, of suitable soil PI 0. ] loldutg Tank C)thcr tispersal Component (expl Pretreatment bevice (expkain)_ V. Ilispet SaN'I t c at ent Area Information:' u_r C 1 r i hsi,r.,u I'I<w (god) pestgn SniE Apphcarinn Eta {gpr Dispersa! ,Area Requited (s . Dispersal Area posed Of) System Elevation "r 't'ank Info Capacity in Total 4 of Manufachtret Ciatlons gallons Llnits Ne„ Tarsl s I xtsling Tanks SrpU+ nr Ilotdtnr Tank 1 llasiu l` t'h +mhet - R't I. I2eslrnnSiblitt} Statement the unrir-r :signed, nssumc rrspnnstbilny far mstatlation of the t'OVV'TS shown on the nttaehcd plans. - _ e - in F Phnni)rr s Nana: print Plumber's Si nmre. RS Number Business PhoricNumber L e77' Plttnther's Addrrss (Sheet, Cily, State, 7,ip Code:) /Ceol tiI mtntyJDepnrtment Use only-. Approval f l Permit Fee Date. Issuer ]ssuin cm Signature 1 ~ 6 ~g ~g ~ Ow ,tvcn Reaso r Denial q55 - 13.. t.onrl wuasrts (w, Atsapproval 3~ ~6 ~ cA ritual a~ p i ~ Vw PK ilpt:Vtsment PO Pwtkled by Ownbei. 1itin*** *-Uw.v its tnutst twmst Ills: ~ a, as aK t1X01l k aa& tuntut~e~. Attach to rantpiete plans for the system and sabmil to tLc C ounty cat}' an paper not ic5s than R t(2 z I.I inches in size `;T'M-fi1W (R. l 1 /1 1) s ve 14, ~2 C`D _pr v~ C~!co CONVENTIONAL COMPONENT OESIGM Ra9idOntlal Application INQEX A NQ MIX PAG I 'ro~~r:t ~1an~n: - - - yv~_e s ~,Z- GtJ ~ ~ - I e(1,91 M.lpsr:riptlon: / - Ig I.flvvtt5ility: ',,ittrfd~/rsic3t~ Name: I. s~i Mumhf~r~ 3~ {-'t~rc:r~l tt r Ntnrrhr~r'. O' a - J 3 ~ hags 1 In~le~ and title i'~ 'YstrR~t_.`izOg & t :crass Section~ Pnga 4 _ dTilter ;spec page 5 Mait~t nc~Ctcc~ Information i'agw Jlenagement Plan P~qe 7 1. C_~°r_rix c optic Tank Maintenance farm Page 1ll~arrant I~ue~d__ _ t'ayP or Flat Attac#~ments: ail `i'e t HooRe Plans C)r~r~Ir~~1arR ~h~mk~er;// , 4c.,G_2~~1Y~?2?_ ~..1G0r1SP.. 1VurrlklPr; ;FR 7 `~igr►s~fuir~ I le.~lgr;~c,~ ~)nr:vN~lll to It1F IIh(3rr11aIlC1 ~'t)II /~hAdi,{~'~~[}Il LoiYtpfnllt•;Il~' fU1tdlvfAl {h I' F'(~SA(iS 1~~rnioq 2_~3 SSf~~1~?7~5~P (t~t.(]41111). Q Su! i % S' T ~J i cot' g_ Bhi jdionf"~F~ r~esT./G'US- ~y b~ V nc L i I Soli Absorpfion System cross section ft 4" Schedule 40 Final Grade PVG Vent Pipe With Vent Cap Leaching - ► Chamber 0 'v- - ' System Elevation _ ft t ft Soil Absor tiara. S stem Plan View ,PS ft -CUT ft Vent Or Observation Pipe Leaching Trench 1 Chambers 4° Dia. Trench 2 Header Leach! ICI Chamber Spee6fica4Ei-nc Manufacturer And Model EISA Rating act sq ft per chamber Soil Application Rate r7 gpd/sq ft gpd Design Flow : 7 Soil Application Rate ; ~k& EISA ~ Chambers 2 rows of W-' " chambers each. Page of l1 J1 21.11u 11:17AM St Croix Co Govt Certe N':i, l;(4 L ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR LrTMIZATION OF EXISTING SEPTIC TANK(S) This is to cettify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 'F~ located at; S V4, ti,,-_ `/4, Section 6, Town 3i N, Range / 5;, W, Town-of .-.-5~~j,7z T St..Croix County Wisconsin, Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements ofSPS. 384.25, and it (they) appear( s) to be functioning properly. Most recent date of inspection or service 2 yr Did flow back-occur from absorption system? Yes No- ~ (if no, skip next line.) A.pproxirtnate volume or length of time: gallons minutes Tank Capacity: % a c, e, Construction: Prefab Concrete X Steel Other Manufacturer (if. k- nown); Age of Tank (if known): r 5~s Peri iit number (if known) (Licensed Plumber Signature) (Print Name) (Title) (License Number) MP/N1PRS ~M (Date) Forn-i to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 -Jail, 6. 20180_1G.41AM St Crnlx Co Govt Center- . U. 5068 F. 1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page--,/ of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al ❑ NA Permit a Septic Tank Manufacturer 13 NA 430314/ I I ttle~~ DESIGN PARAN(ETERS Effluent Filter Manufacturer ~ ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units NA Pump Tank Capacity of JYNA Estimated flow (average) gal/day Pump Tank Manufacturer 121~NA design flow (peak), (Estimated x 1,5! al/da Pump Manufacturer An(NA Soil Application Rate elide /ftz Pump Model .P} NA Standard Influent/Effluent Quality Monthly average' Pretreatment Unit 2KNA Fats, Oil & Grease (FOG) 590 mg/L p Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (13ODJ 5220 mg/L ❑ NA 0 Mechanical Aeration ❑ Watland Total Suspended Solids (T5S) :!9150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Call(s) ❑ NA Biochemical Oxygen Demand JSODJ 530 mg/l. #In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) s30 mg/L ❑ NA d At-Grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu/100ml p Drip-Line ❑ Other: Maximum Effluent Particle Size Y. in die. O NA Other: ❑ NA Other. ❑ NA Others ❑ NA *Values typical for domestic wastewater and eeptic tank effluent. Other., ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: month{s) (Maximum 3 years) ❑ NA ~ ser(a) Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA Inspect. dispersal call(s) At least once every: ❑ month(s) (Mardmum 3 years) ❑ NA JS ear(s) Clean effluent filter At least once every; ❑ month(s) ❑ NA 27 Ayear(s) Inspect pump, pump controls & alarm At least once every; ❑ month(s) IYIA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) A NA O year(s) Other: ❑ month(s) At least once every: ❑ year(s! G NA Other: NA MAINTENANCE NSTRUCTIONS Inspections of tanks and dispersal cells shall biz made by an Individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer: POWTS Inspector, POWTS Maintainer: Septage Servicing Operator. Tank inspections must Include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal call(s) shall be visually inspected to check the effluent levels In the obmwvadon pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the IoCW regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y,) or more of the tank volume, the entire contents of the tank shall he removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servirvng at Intervals of 512 months, shall be performed by a certified POWTS Maintainer. ' A service report shall be provided to the local regulatory authority within 10 days of cwttpled0n of any servloe event. oMW (41011 Jun. 6. 2013 10,41AN1. 5t Crulx Co Govt Center _J.5Q68 . 11 Page of STAfiT UP AND OPERATION V For new construction, prior to use of the POINTS check treatment tank(s) for the presence of paiming products or other chemicals that may impede the treatment process and/or damage the dispersal collie). If high concentrations are detected have the contents of the tank(s) removed by a septage eervleing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal collie) In one large dose, overloading the call(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a plumber or POINTS Maintainer to aselst In manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal rolls. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the Ilfe of the POINTS: antibiotics; baby wipes; clgaratta butts; condoms; Cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water Softener brine. AWW130NMENT When the POWTS falls and/or is permanently taken out of service the following steps shall be taken to insure that the system Is property and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: a All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. a The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. 0 After pumping, all tanks and plts shall be excavated and removed or their covers removed and the void apace filled with sell, gravel or another inert solid material. CONTINOMCY PLAN If the POWYS falls and cannot be repaired the following measures have been, or must be taken, to pn7vida a ovde compliant replacement system; A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules In effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be Installed as a last resort to replace the failed POINTS. ❑ -rho site has not been evaluated to identify a suitable replacement area. Upon failure of the POWYS a eoll and site evaluation must be performed to locate a suitable repWarriant area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POINTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < C WARNING ] ] SEPTIC, PUMP AND OTHM TREATMENT TANKS MAY CONTAIN LETHAL tfA$SES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSUME. ADDITIONAL COMMENTS POINTS INST MUR / LIJ /r%-- - POWYS MAINTAINER Name Name Phone y-- Phone SEPTAOE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name E]Name ' Phoe E one This documar t was drafted In compliance with chapter Comm 83.22(21(b)(1)(dl&Ifl and 8154111, (21 ik (31. Nreconsin Admit sbrative Code. C, 2!12.10 42RM S't Croix Co Gov't. Center Puo, 5068 F'. 1 p ks ~ ~ ~ / a o golf ILIVI a f' lie Q ~s 1r All ,I - I I Z60 1 ' - i y_ o 6 q z¢ a I Q ~ ~ a \ i ,L LL 111 G Io a II r RRr y l w3 EI c~ • • r ~LyJ b. N•1 p SL® byl i ••I ' e 31 ---.-Jun. 0. 20)1Su 10;42AM---St Crolx Co Govt Center No. 5O(2 P. 12 Ali Y off" ~ .r. ~ r 7. 2W w j C\l h C4 F, x ' W w 1. T.\ a X 0 Q \ 1 X of N ` y. Q r Gpl CID rr, rr 2~I II ~~i it ~1 1 ~II C ~j l_V rF'i,. N.~. JL~U F~ 1 ST. CROM COUNTY rTFE 2 ~ SEPTIC T?.,I TT M. ENANCE ACYREEMEYT AI4rD 12018 p TER,EM CERTIEICATIO?J FURM ~J r St. Croix County Jr , PCJ community Devela menr d, (Veribmtioa required from P:mniag 3s Zonb Department for now con^~uction j C,;tvlStat~ -,,n~12~', (tip Parcel Id~.tificatian~ umber _ _ LEGAL DV,;CRT?TION Property Location 1/d , sec:, , T 1 N P.~W, Towr of d Pr , SibrEti sion Plat: l I 1 7° pt 3 1 Z ~4_ 03-2-03 > Lot # 0 Certified Survey Map',, ,Volume , Page # i Warranty Deed # (b~,fare 200T)Volvme , Page. Spey house Cl yes- no Lot lines idmtL5,111yes U' no SYSTy,M M.~TTFNANCE AND OWNER CERTIFICATION i lzaproptr use amd maiutezlaaca ofyoz septic system could rtaih im its premature faRiree to handle wastes. Proper M=Temuce consists of yawing = the septic: tank every fnrec years or sooner, if need: d, by a licensed pump=. What you p LA into the s~,-,ttm can affent the function of the septic tank xs a treatment stage :n the waste aTcisal system. Owner maimte=ce e ansibititios are et;fied iu SPS. 383.52(1) and in i }Ia?ter 1C - St C au CPUtty Sanitazv Grdn~ance. sF The property ov, in agrtcs to submit to SL Croix County Plsng & Zouiug Depart ma t a mei`z4ifioatdon form, signed by the owner and by a master plumber, jouzrie)=an plumber. TMstHdtd plumber ~r-- a 11cemed pumper YcTi~ -d; (1) t1L° am site to "Rates disposal system is in proper operating condition and/or (?i after zispmbm and pumper ffnccess the stptdctmk Lt less than 113 frill of sludge- Lwe, the tmdrrsined have read the above regai.; eumu s and a„ree to maidY the privdw se raga- di?mal 33Tte_m 'vPitb, the, randards set faith, h=i-a, as 5tL by Tht Depa=But of Safety And Pzofesskmal Sm-viccs and the Depx tildnt atNatural Resources, State, of 7llL .oTisin, Certification seating E your septic systm has been mamfiain-..d must be completed and ra=i d to the St aoix County Planning 8. Zang Deportment within 30 days of the three year axpiratiem date. l/we certify that. all statemenlv an L' form are true to the -7e. of mylour lzcrgdedge. Uwe am/ara the owner(s1 of the property descnz ed above, by viitae of a R-an anty dsod ircorded m Re,g~ of Deeds bffacc. k~e~ of bedro 1~ pp ~ i 3C) 1% !ter` SIGNATURE OF APPZJCANT'(9) DATE "**An<< information that is misrepresented: may result in the sanztaay pEc i being revoliod by the Pla=da.g & Z=iag Department. Include with. this application a recorded warranty deed from the Rrgistar of pieeds Offrtt aad a copy of the certified survey map if reference is made m the -w= mty dept! tTt1;V. 04lLZ) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix safety andAuilding Division Sanitary Permit No: INSPECTION REPORT 430314 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes tPrivacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Pinediff Partnership Somerset Township CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No. v I M . D = CST- TAVA* i! 26.31.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FFS ELEV. Septic 6UU &D Benchmark Dosing Alt. BM S r ~ • ~O Aeration Bldg. Sewer Holding SVHt Inlet QO •53 r 8 r TANK SETBACK INFORMATION SUHt Outlet ,0 p • 2 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > Dt Bottom Dosing ' Header/Man. Aeration Dist. Pipe p~ 8.39 0O ystem • ZZ' O Holding Sot. 61.03 Final Grade ' PUMP/SIPHON INFORMATION S. 72 •(oS Manufactur Demand St Cover GPM Model Number 1\ r TDH Lift F ' Loss System Head T Ft Forcemain Length Dia. Dist. to W SOIL A ORPTION SYSTEM OECVRENV Width Leng No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Liquid Depth DIME NS I 1 3 S,-SO j Z SETBACK SYSTEM TO P/L G WELL LAKE/STREAM LEACHING Ma Fturert INFORMATION CHAMBER OR OGl r Type Of System: UNIT Model Number: ' O J1 C,..tl BLD > DISTRIBUTION SYSTEM Header/Manifold tt Distribution x Hole Size Ix Hole Spacing vent to Air Intake P' LengthA!~ Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bedlrrench Edges Topsoil Yes ] No Yes No CO=14o(IDnclude codefiNscrepgp i ss, persons present, etc.) Inspection #1:D-&j 1-/3 Inspection #2: --fir _Cq Location: Somerset, WI 54025 (SW 1/4 NE 1/4 26 T31N R1 9W) NA Lot 36 Parcel No: 26.31.19. 1.) Alt BM Description = ao-T lid 11 ' 1 Clow' 2.) Bldg sewer length = 1 - amount of cover 3 emu' } IOU Plan revision Required? f! Yes No I q I I ' S Use other side for additional information. Date ~ Insepctor's Signature Cert. No. SBD-6710 (R.3/97) r J Ir. 2J1'3_101:4s!~M t i,,.IX Cc 'iiovt Center - -M Nu. JLI~ r. I Wlscpnsin Deparbnefrt of commerce SOIL EVALUATION REPORT Page J,of Division of safety and Buildings in aoDNdance with Comm 95, Wis- Adm_ Code County LI' fd x Attach complete Site plan an paper not Ism than 812 x 11 IntheB in km. Plan must T . Include, but not limited to, vertical and harfzontal reference point (BM), direction and Parcel 1. D' percent slope, scale or dimensions, north emm, mW kmfi n and dlatanee to neamst road. ~~Z - 2 j ~7 3 Please print aH Intbrination. ev by Date Psreunel fnfom>etian you provide may be used for 3EG ndery pub (Pdvsry Low, a 1 S.04 (1) (rn))• sad - in. z X)l property Owner - ` + Property Location L- 3~ C I r v Govt, Lot tu 1/4 f• G 1/4 S L T3/ N R l ti (or 0 ► $ti rt Pup" Owner's Mulling AddreSS k „y La Block # Sub Name or CSM# 86 state zip Code P!1" ,,t+ r ❑Clty ❑ Village Town Nearest Road New Construction Use: a Residential I Number or bedrooms Code oerlved design 11ow rate GPD ❑ FiaPlacentent T ❑ Public Of ODnt al - Describe, Parent matwfal f _ rF f R Flood Plain elevation if applicable ' 1t• General comments fdry and recommendations: 6~t5r'~e. !o J2 J~ ~ ~N GSr Born ~ ~ ~ ~ El ® Pit Ground suftca elev_ • _ IL Depth to limiting factor _,796 in. Sa'l Appir2tion Rath Horizon Depth Dominant Color Redox Description Texture S_"Ctura Conststenoe .0oundary Roots GPWW In_ MunseA Qu. Sz_ Corti. Color Gr. Sz_ Sh. 'Eff#1 `Effli2 1 0-1 Z 0AO-/ k - L 2 r►skh C Cry 4f L, Z 2- 11 C7 hA G 2^S.AA /Iv r C 2M 0rs !i `i 17-11 •r ~ s/ IVA f G 211.1,6,c A1044. C k. 91q D, D V 3L651 Os rti 4- 'z' .5 1,)-; , - F7_1 13or1ng # ~ l3orir~ © pit Ground surface elev. ZdS IL Depth to lin!Mg factor' Y, In. Sal Appkatkn Rate Roots GPD/W Horioa Depth Dominant Color Redox Desa"M Texture Structure Consistence Boundary In, tulur►seB Qu. Sz. Cont. Cabr Gr. Sz- Sh. 'Eff#) 'C-tKF2 12- orb ' rV 3 L 2.~ sk a~ 2 t.t ,s 0 I A4 0, 9 ' 4- . fr . 4 Effluent #1 = BODE, s 3U,4 220 mg/L and TSS >30 < 150 mg4-. ' Effluent #2 = BODs < 3D mg/l. and TSS ~ 30 rrlgfl. CST N (Please P" OWWF 'Z Z ra., a-ne Addr9 Date Evaluation Conducted Telephone Number G GQ•~+~ +"►C tine (9yJ 2S~r U_3 SBD3330 (RO7/00) L III'. rl. L~.~ U 4fA~j~ 1i Cr0 X C,,JVt 'enter_ 0 5 6C~_F' C (ot31S Propwty ner a C /i PO L, d3h.~ Parcel ID # Page ❑ Boring erxirrg # pit Ground surface elev. ~ tY. Depth to limr'6'nq factor~7 /400/ nt. 5011 kcaUon Rate Hori2= Depth Dominant Color Redo>x Description Texture 9tructuure Consistence Boundary Roots GPDMF In. Munsell Qu- Sz. Cone Color Gr. SL Sn `LM 'EffN2 0137 0 G .tw 6.S • 8 l . rfdh C tti. ry 0,7 c~/ yd 7.-~19P Sob QS /11, 7 r F-1 Boring # ❑ 13oring Q pit Ground surFaue elev. N. Depth to llrnitlnp fader 1n SOiI carter Rate Horimn Depth Dominant Color Redox Description Texture structue Consistence Boundary Roots GPDNF in. Munsefl Qu. Si. cont. Color Gr. Sa. Sh. .001 *042 Boring # ❑ Boring F-1 1"`7 pit Ground surface 019v. It. Depth to limiting factor tn. Lt soil rCaticn 1i8t0 I•iorizan Depth Dominant Color Redox Rescrtption Texture Structure Consistence SoaundWy Ruob GPDW in. Mun a Qu. Sz. Cant. Col- Gr. sz. Sh. 'Eff91 'E I • Wuent #1 w BOD, > 30,c 22(] nvyL and TSS >30 < 150 myrL ' Efthmi #2 - SOD,; 30 mg& and M ~ 30 mg/t. I Jbe Department of Commerce is an equal appartumty service provider and employer. If you need assistance to access services Or peed material in an alts mate format, please contact tho depwbncnt at 60$-266r3151 or TTY 648-26¢8777. I J U 2018-10 ; 4 1AM.~St Crolx Co Govt Crnt~r---- - No. 5068 F'Page 3 of 3 0 P~ Name ne CII ~ ,~tv~ d',' Brian Parnell Addresses CST 231314 - Date Benchmark 1_ A Benchmark 2 Sail Baring Suitable Area 1' - 40' Scale I I ' 1 I i ~ I f f i i j "y f i i s 1 ' i { ( f ' ~ ~ i ! I I I I I ~ I I { 1 i y i T r i . 'ml; I C fnC7T_ j _ I I i i r I f I I i I + I I~ ~ I i I I I I I Tr I'A IFS I I i I I { 'r l' ! i I I I ~ I b~t I I I I I I 1 I y i i I I \ I I f i 1 I I ~y~Y~....7-.._' I I I I r I r-7'- -'~-T- i~- ` I 1 I I ' I ; j ~I ' 44 1 ' I ' { I r ~ ! I I I 1 I I I i I I i l I I ; t it 4 I I i f i F - i~ - i i s I 4 F y I I I I 1 f I T-~ i I I I I I - 13 4 I I I I I I I E I I I I! i f l I ! j i i ' c I y ! j ~ I 1~ ~ r I I ~ I I I I h- ~ i T •~-rte - ; , y ~ i